Telemedicine from Costa Rica!

I wanted to give a big HELLO to my nurse practitioner sisters and brothers from sunny Costa Rica! I am on a long-deserved CME vacation down here hanging out on the beach, drinking piña coladas, doing a little surfing and fishing, and most of all, just relaxing and catching up on some much-needed sleep. Unfortunately for the nurse practitioner entrepreneur though, work never totally stops…

Owning your own practice is like having a child. You love it, hate it (at times), and always have it on your mind. It is something that you must take care and watch very closely when you first get started. Once it gets older though, it starts taking care of itself! For the nurse practitioner entrepreneur that sees patients though, that part of the business falls on you alone (unless you hire other NPs to see patients for you).

For me, I have patients to see and also The Elite NP to take care of… Just because I am on vacation doesn’t mean there aren’t NPs that still need help with wanting to break free and some men’s health patients to see! So, I am down here right now typing this article out while lying in a hammock with the views of the ocean in front of me (article picture, ocean on other side of trees) and the sounds of monkeys in the trees above me. Additionally, I just wrapped up seeing some follow up visits for my men’s health clinic about an hour ago utilizing the awesomeness of telemedicine, so I do not get behind!

The process was a piece of cake… I have seen all these patients at least once before, so they were just follow ups. They had their lab work done in the last 1-2 weeks and were scheduled by my medical assistant for today knowing that I was going to be in Costa Rica. I simply logged into my EMR, reviewed my previous notes, checked out their new lab results and compared them to the previous ones, connected with them through my EMR for the telemed visit, adjusted their dose/addressed any issues, texted my medical assistant of any changes, and that was it! It really is that SIMPLE and took me a whole 2 hours…

Utilizing telemedicine as a nurse practitioner is one of the best things you can do to increase your freedom exponentially. This is what I call “location independent income.” Essentially, you can live and travel wherever you want and still work. All that is required is a decent internet connection (even the Caribbean Coast of Costa Rica has high speed fiber internet!) and a computer…

Have you ever heard of the stories of the radiologists that do remote reads on their sailboats in Australia? Yea, well nurse practitioners can do the same thing now! All it takes are the appropriate steps to be implemented in your life to make it happen:

  1. Pick your niche idea.
  2. Create a telemedicine practice.
  3. Get licenses in whatever full practice authority states you want (more the better for a dedicated telemedicine practice).
  4. Market the living hell out of it.
  5. Profit.

It really is that simple. Of course, there are quite a few processes involved with it, but that is essentially it. ANYONE can do this… It really is the future of practice. Patients are looking for convenient care that can be done out of the comfort of their own home. Deliver the demand, provide value, and enjoy the benefits of it… Like working from wherever you want!

My men’s health practice is a hybrid model though. We are a brick-and-mortar practice but also do a lot of visits via telemedicine. I typically see my patients in person for their first appointment, but with the DEA restrictions being lifted right now secondary to COVID, we have been seeing a few without that initial in person appointment, but overall, 90% are still seen in person first. After that, the majority of follow up visits are just done via telemed. My patients are busy men, they don’t have time to come see me for a 10-minute visit to review labs and symptoms… Having a hybrid model is also beneficial because it allows you to dispense medications (if your state allows you to do that), give injections, draw labs in house, and do procedures like joint injections or IV infusions.

My 2nd men’s health location is a hybrid model as well. As I expand my practice to 3, 4, 5 or more offices, I will continue to do the hybrid model as many of my patients like to actually shake a hand and see you face to face. I think that aspect of care will never go away for some people. So, there is utility to it.

But yes folks, telemedicine is awesome. Come on, could you have IMAGINED being able to work while sitting on the beach 20 years ago? Sure, I am on vacation and shouldn’t work, but the fact of the matter is that I have obligations and still need to do a LITTLE work. Hell, I saw 10 follow ups over the span of 2 hours and made a nice cash profit! Now I am DONE for the rest of the trip! How awesome is that?

When I had my transgender telemedicine practice before I sold it, we had an NP that moved to South America and still saw patients here in the states… More and more providers of all disciplines are moving towards this delivery method. COVID sucks, no doubt about it, but how it has reshaped telemedicine is a benefit for many.

As you go through your nurse practitioner entrepreneurial journey, ensure that you integrate telemedicine services into your practice, regardless of what you do. Many service lines are more hands on, such as Aesthetics or Ketamine Infusion, so ensure you also offer a few niche services like weight loss or HRT that can be done remotely as well. This will increase the redundancy in your business life and help you be freer.

This is a quick one today guys. I am going to take a quick dive in the pool for a bit and then walk to a cool little bar down the beach and have some fresh seafood and a mojito! Catch everyone next week. God bless 😊

6 Responses

  1. My husband and I are looking to retire abroad… somewhere warm, palm trees and warm seas. I have started a telemedicine practice and need some growth before we relocate.

    Do you work remote and check in in person once a month, or every other month for in clinic appointments?

    Thanks!
    Deanna 🌴🌞🥂🍾

    1. I do not work remotely 100%. If I did, I wouldn’t bother checking in person once a month. It is unnecessary for many services. So, it ultimately depends on what it is you want to do!

  2. Nurse practitioners, do your homework on this before you jeopardize your license and DEA certification. I contacted the DEA prior to traveling to Costa Rica as I was planning to provide telemedicine services from Costa Rica to my patients in Minnesota and was provided with the following abbreviated statement when inquiring about prescribing controlled substances from abroad “In this instance, the Controlled Substance Act does not cover foreign countries, so you would be practicing telemedicine in a foreign country where you are not authorized to practice medicine”. The temporary exception related to COVID-19 applies only to practice within the United States. Additionally, providers cannot bill for telemedicine services from abroad for patients with Medicare or Medicaid as these are federally funded programs within the United States. This was confirmed by CMS. Billing for such services while abroad may result in charges of Medicare fraud. Best advice, these blogs are helpful, but contact a reputable international healthcare attorney before you risk the licenses and certifications you have worked so hard to obtain.

    1. 1. You are not practicing medicine in Costa Rica. You are simply providing a phone consultation to patients in a state you are licensed in. Where you are at at the time of the call makes no difference. What is the difference between being in Florida (where you have no license) and talking to a patient in Minnesota where you have a license in? You are not practicing medicine in FL…. Same principle applies

      2. Stick with cash only, and it is a mute point.

      Thanks for the comment and the concerns.

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